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Health, Experienced Support and School Performance among Children in Out-of-home care
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Barnafrid.ORCID iD: 0000-0002-2958-6952
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Children in out-of-home care (OHC) have higher risks for developing poorer health and school achievement, being subjected to more abuse experiences, as well as negative long-term outcomes related to occupational performance, socioeconomic status, addiction, and criminality. Research related to OHC children is fragmented and the effects of interventions are under-studied.

This thesis aimed to explore health, abuse, support, and preconditions for school among children in OHC and to assess changes after an intervention targeting foster children’s school performance.

Paper I compared OHC pupils in last year high school to non-OHC peers in a national survey with 5 839 pupils. The study showed that risks of abuse and poor mental health are evident for adolescents in out-of-home care. Also, results indicated a lower disclosure rate of sexual abuse, particularly to police or social services.

Paper II compared OHC pupils to peers in birth parent care by analyzing responses in four consecutive year surveys in a regional sample comprising 23 798 pupils in 8th-year compulsory and 2nd-year high school. Responses from the 311 pupils in OHC showed poorer outcomes than did birth-parent care peers in perceived satisfaction with social life and relations, trust to other persons in different relations, abuse experiences online, and sense of security in the school and at home. These results also applied when compared to a subset of pupils living with a single birth parent.

Paper III analyzed prospective test and questionnaire data of intelligence, adaptive behavior, mathematics, literacy skills, and psychosocial wellbeing from 856 children in foster care. Results revealed poorer preconditions for school performance of between 0.5 and 1.0 standard deviations below age-standardized norms. The analysis also provided results regarding different intelligence domains, where working memory showed the lowest scores while perceptual functioning were close to norms. Boys generally scored poorer than girls except in mathematics.

Paper IV explored the effects of a school-based intervention, Skolfam, on a subset of Paper III cohort (n= 475). Results showed improved skills in higher-order cognitive executive functions such as reading comprehension, sentence chains, mathematics, and intelligence. For less complex cognitive functions, affective functioning or psychosocial symptoms, no improvements were seen, except for reduced hyperactivity.

Conclusion: The studies confirm that children in OHC have poorer mental health, are less satisfied with social life, have more adverse experiences both online and in real life and have poorer preconditions for school performance than do non-OHC peers. Importantly, Skolfam intervention can partially enhance preconditions for school performance. Further studies on longitudinal risk, with a design to identify specific protective factors, development of school-related competencies and ways to support OHC children in school are needed.

Abstract [sv]

Barn i social heldygnsvård har som grupp högre risker för att utveckla sämre hälsa och skolresultat, vara mer utsatta för övergrepp samt ha sämre långtidsutsikter relaterat till arbetsmarknad, socioekonomisk status, drogberoende och kriminalitet. Forskning om barn i social heldygnsvård är ofta fragmenterad och effekter av olika interventioner är sparsamt utvärderade.

Syftet med avhandlingen var att utforska hälsa, stöd, övergrepp och förutsättningar för skola för barn i social heldygnsvård, samt att bedöma hur förutsättningar för skolprestation förändras genom en intervention som inriktas mot skolresultat för barn i familjehem.

Artikel I jämförde samhällsvårdade studenter i tredje året på gymnasiet med icke samhällsvårdade jämnåriga studenter. 5 839 elever besvarade en nationell enkät. Resultatet visade att risker för övergrepp och sämre psykisk hälsa var mer frekvent för ungdomar i samhällsvård. Dessutom var andelen som berättar om övergrepp lägre bland de samhällsvårdade ungdomarna, i synnerhet till polis och socialtjänst.

Artikel II jämförde samhällsvårdade elever med jämnåriga som bor med föräldrar, genom att analysera svaren från fyra på varandra följande års enkäter i ett regionalt urval som omfattade 23 798 elever från grundskolans åttonde och gymnasieskolans andra år. Svaren från de 311 eleverna i samhällsvård visade sämre utfall än icke samhällsvårdade i upplevd tillfredsställelse med socialt liv och relationer, tillit till andra personer i olika relationer, erfarenhet av nätövergrepp, samt upplevd säkerhet såväl i skolan som i hemmet, även i jämförelse med en undergrupp av studenter som bor med bara en förälder.

Artikel III analyserade test- och formulärdata av intelligens, adaptivt beteende, matematik, läsfärdigheter och psykosocialt mående av 856 barn i familjehem. Resultaten visade sämre förutsättningar för skolprestation mellan 0.5 och 1.0 standardavvikelser under åldersstandardiserade normer. I analysen från olika domäner av intelligens, visade arbetsminne de lägsta resultaten, medan perceptuell funktion visade sig ligga nära medelvärdet från normeringsstudier. Pojkar hade generellt lägre poäng än flickor, förutom i matematik.

Artikel IV undersökte effekter av en skolbaserad intervention, från ett antal elever från Skolfam kohorten (n = 475). Resultaten visade förbättrade färdigheter i högre exekutiva funktioner som läsförståelse, meningskedjor, matematik, samt intelligens efter intervention. För mindre komplexa kognitiva funktioner, affektiv funktion eller psykosomatiska symptom noterades inga förändringar, med undantag för lägre hyperaktivitet.

Slutsatserna från dessa studier bekräftar bilden av att barn i samhällsvård har sämre psykisk hälsa, är mindre tillfreds med sitt sociala liv, har mer erfarenheter av övergrepp såväl på nätet som i verkliga livet och har sämre förutsättningar för skolresultat än sina icke samhällsvårdade jämnåriga. Ett viktigt bidrag är att interventionen Skolfam till del kan stärka förutsättningar för bättre skolprestation. Fortsatta studier av longitudinella risker, med möjlighet att identifiera specifika skyddsfaktorer, modeller för att utveckla skolrelaterade kompetenser och sätt att ytterligare stödja barn i samhällsvård behövs.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. , p. 88
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1739
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-165555DOI: 10.3384/diss.diva-165555ISBN: 9789179298593 (print)OAI: oai:DiVA.org:liu-165555DiVA, id: diva2:1428663
Public defence
2020-06-05, Online: Kontakta Andreea Tanasa, andreea.tanasa@liu.se för länk till disputationen online, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-05-06 Created: 2020-05-06 Last updated: 2020-05-15Bibliographically approved
List of papers
1. Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample
Open this publication in new window or tab >>Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample
Show others...
2019 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 16-23Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents.

MATERIALS AND METHODS: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze.

RESULTS: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care.

CONCLUSIONS: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Out-of-home care, child sexual abuse, foster home care, mental health, residential care
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-159924 (URN)10.1080/08039488.2018.1527397 (DOI)000466445300003 ()30561234 (PubMedID)2-s2.0-85058791083 (Scopus ID)
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2020-05-06Bibliographically approved
2. Challenging intellectual, behavioral and educational prerequisites for interventions aimed at school aged children in foster care. A compilation of Swedish test results
Open this publication in new window or tab >>Challenging intellectual, behavioral and educational prerequisites for interventions aimed at school aged children in foster care. A compilation of Swedish test results
2020 (English)In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 108, article id 104598Article in journal (Refereed) Published
Abstract [en]

Children in foster care constitute a vulnerable group with higher risks for exposure to poorer health, adverse experiences during childhood and poor performance in school. School success is considered one of the most important factors to prevent future adversity and there is a growing interest in society for school results for children in foster care or other out-of-home care arrangements. The purpose of this study was to outline prerequisites for interventions aimed at school performance for children in foster care, related to those in normal population studies. In this study assessments of intelligence, literacy and numeracy skills, mental and behavioral conditions were compiled from 856 children in foster care, between preschool class and 7th grade from 22 Swedish municipalities. Results show lower scores in intelligence, most prominent in working memory, adaptive behavior, literacy and numeracy, and more behavioral problems. Ingroup comparisons showed less favorable scores for boys than girls in general, except in mathematics. These findings call for a need to adapt learning conditions in school by individual assessments of children in out-of-home care, rather than assuming age-typical prerequisites.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2020
Keywords
Foster children; Intelligence; School performance; Literacy skills; Numeracy skills; Assessments
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-164167 (URN)10.1016/j.childyouth.2019.104598 (DOI)000509819500021 ()
Note

Funding Agencies|Childress Welfare Foundation, Stockholm, Sweden [2019/255]; FORTE, the Swedish Research Council for Health, Working Life and Welfare

Available from: 2020-03-11 Created: 2020-03-11 Last updated: 2020-05-06
3. Improved Intelligence, Literacy and Mathematic Skills Following School-Based Intervention for Children in Foster Care
Open this publication in new window or tab >>Improved Intelligence, Literacy and Mathematic Skills Following School-Based Intervention for Children in Foster Care
2020 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 11Article in journal (Refereed) Published
Abstract [en]

Interventions aimed at improving school performance for children in foster care are few and are generally not implemented. By preventing failure in school, the prospect of reducing the risk for future poor health, substance abuse, unemployment, and other detrimental social conditions are met. This paper focuses on the change of preconditions for compulsory school performance in out-of-home care children, following an intervention called “Skolfam” that aims to improve school performance by individual assessments and school-based interventions. In this study, data were compiled from prospective repeated tests of 475 children in foster care in Sweden. Educational preconditions were analysed for compulsory school performance, such as intelligence (WISC-IV), psychosocial (SDQ) and adaptive behavior (ABAS-II), literacy (Reading Chains) and mathematical skills (Magne Mathematic Diagnoses) before and after the first 2 years of the “Skolfam” intervention. All tests were age-standardized and performed by experienced professionals. The results showed improved skills in complex aspects of literacy, mathematics, and cognitive performance, but no improvement in less complex literacy skills, adaptive behavior or mental health symptoms. In conclusion, higher-order cognitive functions can develop positively when appropriate school support is provided. Affective function, adaptive behavior, and psychosocial well-being present a more pervasive challenge for children in foster care. Implications for future research, practice in social services, and school is that further development of methods to aid future prospects for children in out-of-home care should aim to improve both cognitive higher-order executive-, and affective functions.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2020
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-165505 (URN)10.3389/fpsyg.2020.00718 (DOI)
Note

Funding Agencies: Childress Welfare Foundation, Stockholm, Sweden; FORTE, the Swedish Research Council for Health, Working Life and Welfare

Available from: 2020-05-05 Created: 2020-05-05 Last updated: 2020-05-12Bibliographically approved

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12345671 of 13
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